@zzonner
I'm sorry to hear you are struggling with post treatment depression or other mood disorders.
Unfortunately, this is a fairly common occurrence in 18-25% of cancer patients according to the recent literature on the topic. Distressingly, it is a topic that is rarely discussed in depth by oncologists or other members of the care team as many feel that while it may be a legitimate issue for some patients, it's not in their clinical wheelhouse. As such many don't feel comfortable about addressing the issue or making clinical recommendations other than a trial of various antidepressants.
The sources of cancer treatment related depression and other mood disorders are multifactorial in nature. First, there is the mental fog (a.k.a chemobrain) that almost every patient experiences. It is generally attributable to the release of lysed cellular contents which induces the released of inflammatory cyotikines. These in turn, active what is known as the NLRP3 inflammasome. This may may induce neuroinflammation and associated symptoms of mood changes and depression.
Also, there are a number of chemotherapy regimens, such as FOLFOX, that incorporate folinic acid, 5 fluro deoxyuridine (5FU) and oxyplatin in varying amounts. Each of these agents has been shown to be associated with increased rates of depression in significant subsets of patients treated for varying intervals with varied regimens in various clinical studies.
More recent studies have demonstrated that 5 FU in particular induces significant changes in the normal gut microbiome.
If you have been following the public or clinical literature in regard to the alterations in the gut microbiome and it's effects on the gut-brain axis, and the subsequent development of depression and anxiety. As clinicians have become more aware of the deleterious effects of cancer treatments in inducing changes in patients’ gut microbiomes and the link to their mental status, they have begun to tailor their approach to therapeutic interventions. ⁷This may include the recommendation of a probiotic supplement to replenish the healthy bacterial species that may have been diminished by their various chemo and immunotherapies.
I’ve experienced some relief and improvement with my chemo- induced brain fog, moodiness and depression with a daily probiotic regimen while on FOLFOX and FOLFIRI chemotherapy. My regimen was prepared in consultation with a nutritionist on my care team.
Another key in my fight with the blues is regular exercise. I try to walk, use my under the desk elliptical machine with variable resistance, light weights and resistance bands for at least 90 min 3-4 times a week.
I know it’s been a tough slog to get where you are in your battle with this disease. Savor the small victories and while difficult, you must maintain a positive mental attitude. You must resolve to own your disease and not let it own you.